Whole-Person Health and the Five Pillars of Islam: A Critical Narrative Review and Health-System Framework for Nigeria

Abstract

Background: The Five Pillars of Islam may influence health through meaning, daily routine, embodied movement, social redistribution, fasting practices and mass-gathering preparedness. However, faith-health literature often conflates devotional significance with clinical efficacy and gives insufficient attention to adverse effects, lawful exemptions, governance and pluralism. Objective: To critically appraise published evidence relevant to the Five Pillars and whole-person health, and to develop an ethically bounded, Nigeria-relevant framework across primary, secondary, tertiary and quaternary prevention. Methods: This critical narrative review was informed by the Scale for the Assessment of Narrative Review Articles. PubMed/MEDLINE and targeted bibliographic searches of journal platforms and official Nigerian sources were undertaken for literature available to July 2026. Peer-reviewed reviews, meta-analyses, clinical guidance, policy analyses and relevant primary studies were prioritised. Unpublished presentations, unverifiable citations, duplicated sources and articles used solely as formatting exemplars were excluded. Every retained reference was checked against a journal record, DOI, PubMed record or official publication catalogue. Results: The evidence is uneven. For Shahadah, health inferences are indirect and arise mainly from broader research on meaning, religious coping and dignity. Salah may support structure, gentle movement and contemplative regulation, but the clinical evidence remains limited and heterogeneous. Quran recitation may reduce situational anxiety, although study quality and generalisability vary. Zakat has a plausible role in social protection and access to care, but direct evidence of health outcomes is sparse and implementation requires transparent pooling, eligibility, purchasing and audit. Ramadan fasting produces small and usually transient metabolic changes in healthy adults, while people with chronic illness require risk stratification and medication planning. Hajj has the strongest population-health evidence through mass-gathering medicine, vaccination, surveillance, heat protection and emergency preparedness. The review proposes the PILLARS-P4 framework, where P4 refers to the four levels of prevention. Conclusion: The Five Pillars can provide culturally meaningful entry points for whole-person care without being medicalised. Responsible application requires evidence-based treatment, voluntary spiritual care, lawful exemptions, inclusive access, robust financial governance and safeguards against both under-treatment and overmedicalisation.